Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1013457977 |
---|---|
Provider Name | Jenna Spears |
First Address | Braselton, GA 30517-1641 |
Second Address | Lawrenceville, GA 30043-2530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2017 |
Last Update Date | 26/02/2017 |