Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC2147 | MD |
NPI | 1003033945 |
---|---|
Provider Name | Deana Reynolds Rios |
First Address | La Plata, MD 20646-2984 |
Second Address | Laplata, MD 20646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
58956180 | (05) | MD |