Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 1768 | MS |
NPI | 1003252743 |
---|---|
Provider Name | Elizabeth Ann Smith |
First Address | Ocean Springs, MS 39564 |
Second Address | Ocean Springs, MS 39564-3949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 21/05/2013 |