Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | APC004180 | GA |
N | 101YS0200X | School Counselor | 1071653 | GA |
NPI | 1114327772 |
---|---|
Provider Name | Lawanda Owens |
First Address | Stockbridge, GA 30281-6216 |
Second Address | Lawrenceville, GA 30046-8444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2014 |
Last Update Date | 01/09/2014 |