Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LC5215 | MD |
NPI | 1215366208 |
---|---|
Provider Name | Jamie Eaton |
First Address | Frederick, MD 21702-8212 |
Second Address | Frederick, MD 21702-8212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2013 |
Last Update Date | 11/11/2013 |