Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 3612G | AL |
NPI | 1003287764 |
---|---|
Provider Name | Krystina Mcallister |
First Address | Huntsville, AL 35802-4364 |
Second Address | Huntsville, AL 35802-4364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2015 |
Last Update Date | 07/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
330000014 | (05) | AL |