Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 103124 | KY |
NPI | 1003168949 |
---|---|
Provider Name | Dreama Wooton |
First Address | Hazard, KY 41701-9415 |
Second Address | Jackson, KY 41339-8675 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2012 |
Last Update Date | 29/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71002873520 | (05) | KY |