Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | GA |
NPI | 1225406366 |
---|---|
Provider Name | Andrew Holiday III |
First Address | Riverdale, GA 30296-7195 |
Second Address | College Park, GA 30349-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2015 |
Last Update Date | 07/09/2015 |