Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2835 | AL |
NPI | 1003241431 |
---|---|
Provider Name | Amy Conway |
First Address | Mobile, AL 36693-3316 |
Second Address | Daphne, AL 36526-5274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 04/09/2013 |