Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5034 | AL |
NPI | 1538774559 |
---|---|
Provider Name | Haley Etheridge |
First Address | Gadsden, AL 35904-3104 |
Second Address | Gadsden, AL 35903-1100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 15/09/2020 |