Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC010785 | PA |
NPI | 1003383431 |
---|---|
Provider Name | Jessica Mcdonough |
First Address | Moosic, PA 18507-1707 |
Second Address | Moosic, PA 18507-1707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 19/02/2019 |