Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1194477364 |
---|---|
Provider Name | Leonard A Carter |
First Address | Evanston, IL 60202-2707 |
Second Address | Evanston, IL 60202-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2022 |
Last Update Date | 19/01/2022 |