Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | A15043 | NC |
N | 225C00000X | Rehabilitation Counselor | 00326695 |
NPI | 1164076238 |
---|---|
Provider Name | Jessica Nicole Newman |
First Address | Greenville, NC 27834-1079 |
Second Address | Greenville, NC 27834-1079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2019 |
Last Update Date | 27/07/2019 |