Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 103TA0700X | Adult Development & Aging Psychologist |
NPI | 1881228914 |
---|---|
Provider Name | Annette Smith |
First Address | Jenkinsburg, GA 30234-2028 |
Second Address | Jenkinsburg, GA 30234-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2020 |
Last Update Date | 27/02/2020 |