Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003106097 |
---|---|
Provider Name | Dr. Ashley L Maltez-Laurienti |
First Address | Ft. Gordon, GA 30905 |
Second Address | Fort Polk, LA 71459-5102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 01/10/2021 |