Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 39003727A | IN |
NPI | 1003200775 |
---|---|
Provider Name | Alicia Jean Digiulio |
First Address | Fort Wayne, IN 46814-8998 |
Second Address | Fort Wayne, IN 46835-9259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2015 |
Last Update Date | 11/03/2020 |