Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0000369 | GA |
NPI | 1003168469 |
---|---|
Provider Name | Eleanor Mcmichael Stewart |
First Address | Atlanta, GA 30305 |
Second Address | Atlanta, GA 30305-1578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2012 |
Last Update Date | 10/10/2012 |