Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LPC0460030715 | FL |
NPI | 1225583859 |
---|---|
Provider Name | Jacqueline Montgomery |
First Address | Orlando, FL 32811-5544 |
Second Address | Orlando, FL 32811-5544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2016 |
Last Update Date | 24/08/2016 |