Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 008972 | GA |
NPI | 1003452319 |
---|---|
Provider Name | Danny Robinson |
First Address | Hephzibah, GA 30815-7075 |
Second Address | Augusta, GA 30909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2019 |
Last Update Date | 21/11/2019 |