Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 7146 | OH |
NPI | 1083006167 |
---|---|
Provider Name | Gregory Clifford Alfred |
First Address | Columbus, OH 43219-1834 |
Second Address | Columbus, OH 43219-1834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2015 |
Last Update Date | 25/02/2015 |