Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 20283 | AL |
NPI | 1194295832 |
---|---|
Provider Name | Dr. Joe Mack Bankhead |
First Address | Sulligent, AL 35586-4603 |
Second Address | Sulligent, AL 35586-4603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2018 |
Last Update Date | 26/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20283 | (05) | AL |