Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1336615194 |
---|---|
Provider Name | Dr. Myrna Thurmond Malone |
First Address | Riverdale, GA 30274-4682 |
Second Address | Riverdale, GA 30274-2027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2018 |
Last Update Date | 19/10/2018 |