Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1124501101 |
---|---|
Provider Name | Callie Elizabeth Quillen |
First Address | Corbin, KY 40701-2356 |
Second Address | London, KY 40741-9029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2018 |
Last Update Date | 14/09/2018 |