Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003190034 |
---|---|
Provider Name | Kristina Marie Frazier |
First Address | Middleboro, MA 02346-1943 |
Second Address | Middleboro, MA 02346-1943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2011 |
Last Update Date | 12/03/2019 |