Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | NCC 28936 | AZ |
NPI | 1053525279 |
---|---|
Provider Name | Kim Carter |
First Address | Phoenix, AZ 85028-2619 |
Second Address | Phoenix, AZ 85006-3324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |