Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LCCT 0330020611 | FL |
NPI | 1366796260 |
---|---|
Provider Name | John Stiteler |
First Address | Orlando, FL 32811-2631 |
Second Address | Orlando, FL 32819-7940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2012 |
Last Update Date | 31/10/2012 |