Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | GA |
NPI | 1235534868 |
---|---|
Provider Name | Jung Mi Han |
First Address | Duluth, GA 30097-6221 |
Second Address | Duluth, GA 30097-6221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2014 |
Last Update Date | 24/10/2014 |