Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 78382 | TX |
N | 101YS0200X | School Counselor | 178518 | MS |
NPI | 1194114793 |
---|---|
Provider Name | Lakeisha Mcdonald-Theodore |
First Address | Spring, TX 77379-8256 |
Second Address | Spring, TX 77379-8256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 17/03/2018 |