Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003325010 |
---|---|
Provider Name | Amber Lynn Chisholm |
First Address | Springfield, MA 01103-2202 |
Second Address | Springfield, MA 01103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 21/09/2017 |