Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10053 | FL |
Y | 101YM0800X | Mental Health Counselor | 10053 | FL |
NPI | 1003122250 |
---|---|
Provider Name | Kitty Darlene Slark |
First Address | Ellenton, FL 34222-3227 |
Second Address | Avon Park, FL 33825-9348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2010 |
Last Update Date | 26/08/2010 |