Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH8414 | FL |
NPI | 1003108986 |
---|---|
Provider Name | Dawn S. Liphart |
First Address | Jacksonville, FL 32256-8507 |
Second Address | Jacksonville, FL 32246-6685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 10/05/2011 |