Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LPC007677 | GA |
NPI | 1003232968 |
---|---|
Provider Name | Carla Myers |
First Address | Red Bank, TN 37415-2746 |
Second Address | Ft. Oglethorpe, GA 30742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2014 |
Last Update Date | 14/03/2014 |