Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1073953501 |
---|---|
Provider Name | Dr. Mark Franklin Patishnock |
First Address | Blacksburg, VA 24061-0001 |
Second Address | Blacksburg, VA 24061-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 13/08/2013 |