Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 259970 | KY |
NPI | 1003165119 |
---|---|
Provider Name | Charlotte Williamson |
First Address | Ashland, KY 41105-0790 |
Second Address | Louisa, KY 41230-9644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2012 |
Last Update Date | 25/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30610026 | (05) | KY |