Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003232513 |
---|---|
Provider Name | Brandi Dunn |
First Address | Ashland, KY 41105-0790 |
Second Address | Ashland, KY 41102-5422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2014 |
Last Update Date | 06/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30610026 | (05) | KY |