Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 9083 | NC |
NPI | 1003189812 |
---|---|
Provider Name | Christine Ann Wisdom |
First Address | Cornelius, NC 28031-6873 |
Second Address | Cornelius, NC 28031-6873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2012 |
Last Update Date | 24/06/2015 |