Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 15 | NC |
NPI | 1003067695 |
---|---|
Provider Name | Dr. Jeff Randall Mishoe |
First Address | Charlotte, NC 28203-4891 |
Second Address | Charlotte, NC 28203-4891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 01/10/2008 |