Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2516 | GA |
Y | 103TC0700X | Clinical Psychologist | 2516 | GA |
NPI | 1003892738 |
---|---|
Provider Name | Dr. Helen Barnes Vantine |
First Address | Marietta, GA 30060-6987 |
Second Address | Marietta, GA 30060-6987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00917265A | (05) | GA |