Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 3599 | AL |
NPI | 1003317264 |
---|---|
Provider Name | Candace Penn |
First Address | Troy, AL 36081-4664 |
Second Address | Andalusia, AL 36420-9234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2018 |
Last Update Date | 23/02/2018 |