Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003304932 |
---|---|
Provider Name | Emily Reiner |
First Address | Austell, GA 30106-1580 |
Second Address | Kennesaw, GA 30152-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 26/04/2018 |