Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 171M00000X | LA |
NPI | 1003486903 |
---|---|
Provider Name | Chalei Rayveon Knox |
First Address | Tallulah, LA 71282-3706 |
Second Address | Tallulah, LA 71282-3706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2021 |
Last Update Date | 01/07/2021 |