Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MA | |
Y | 101YM0800X | Mental Health Counselor | MH12182 | FL |
N | 101YP1600X | Pastoral Counselor |
NPI | 1295977023 |
---|---|
Provider Name | Elizabeth Rose Charles |
First Address | Pensacola, FL 32514-8158 |
Second Address | Pensacola, FL 32514-1670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2009 |
Last Update Date | 10/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010365700 | (05) | FL |