Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1326515636 |
---|---|
Provider Name | Jacqueline Beckhom |
First Address | Rex, GA 30273-1244 |
Second Address | Atlanta, GA 30324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 25/10/2018 |