Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003154691 |
---|---|
Provider Name | Dr. Bianca Fetherson |
First Address | Lanham, MD 20706-6205 |
Second Address | Lanham, MD 20706-6205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 14/09/2019 |