Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000471 | VA |
NPI | 1083104293 |
---|---|
Provider Name | Jonathan Lineburg |
First Address | Luray, VA 22835-1030 |
Second Address | Luray, VA 22835-1030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 14/05/2018 |