Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003452590 |
---|---|
Provider Name | Alicia Kendorski |
First Address | Millsboro, DE 19966-3156 |
Second Address | Millsboro, DE 19966-3156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2019 |
Last Update Date | 20/11/2019 |