Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1003204801 |
---|---|
Provider Name | Dwight Roberts |
First Address | Louisville, KY 40202-1423 |
Second Address | Louisville, KY 40220-2340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2014 |
Last Update Date | 31/12/2014 |