Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003246224 |
---|---|
Provider Name | Annette Bogan |
First Address | Thomasville, GA 31792-5556 |
Second Address | Cairo, GA 39828-3383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 23/02/2021 |