Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor |
NPI | 1003325119 |
---|---|
Provider Name | David Lee Ford JR. |
First Address | Chittenango, NY 13037-9731 |
Second Address | Syracuse, NY 13202-1888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 21/09/2017 |