Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1124591706 |
---|---|
Provider Name | Eunice Wilkerson |
First Address | Shreveport, LA 71109-6001 |
Second Address | Shreveport, LA 71109-6001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2019 |
Last Update Date | 17/01/2019 |