Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.009390 | IL |
NPI | 1003207077 |
---|---|
Provider Name | Angelica Newton |
First Address | Cary, IL 60013-1234 |
Second Address | Mchenry, IL 60050-8350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2015 |
Last Update Date | 12/02/2015 |