Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1184908600 |
---|---|
Provider Name | Irene Marie Lewis-Wimbley |
First Address | Sterling, IL 61081-2862 |
Second Address | Sterling, IL 61081-4151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2011 |
Last Update Date | 03/10/2011 |