Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1003269804 |
---|---|
Provider Name | Alacia Mason |
First Address | Baton Rouge, LA 70806-3826 |
Second Address | Baton Rouge, LA 70806-3826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2016 |
Last Update Date | 15/07/2016 |