Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1174832174 |
---|---|
Provider Name | Dr. Latoya Bernice Gathers |
First Address | Georgetown, SC 29440-3078 |
Second Address | Conway, SC 29527-4848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2010 |
Last Update Date | 29/08/2011 |