Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 16987 | NY |
NPI | 1316421514 |
---|---|
Provider Name | Gail Dehart |
First Address | Gouverneur, NY 13642-4114 |
Second Address | Gouverneur, NY 13642-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2018 |
Last Update Date | 24/09/2018 |