Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TS0200X | School Psychologist |
NPI | 1043336225 |
---|---|
Provider Name | Gretchen Whitman |
First Address | Marion, SC 29571-2517 |
Second Address | Marion, SC 29571-2517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 09/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
376241 | (05) | SC |