Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701006030 | VA |
NPI | 1003291964 |
---|---|
Provider Name | Chaniece Winfield |
First Address | Moyock, NC 27958-9046 |
Second Address | Suffolk, VA 23434-5322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2015 |
Last Update Date | 21/07/2015 |