Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 029748 | NY |
NPI | 1003055450 |
---|---|
Provider Name | Donna C Bjorkman |
First Address | Hartford, CT 06150-1904 |
Second Address | Glens Falls, NY 12801-3549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2009 |
Last Update Date | 09/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01420800 | (05) | NY |