Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1093101321 |
---|---|
Provider Name | Jamaal Crone |
First Address | Arlington, VA 22206-3052 |
Second Address | Arlington, VA 22206-3052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 23/07/2015 |