Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC000233 | PA |
NPI | 1003089046 |
---|---|
Provider Name | Barbara Brundige Decker |
First Address | Waverly, PA 18471 |
Second Address | Waverly, PA 18471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 10/04/2008 |