Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6799 | NC |
NPI | 1003093923 |
---|---|
Provider Name | Lia Deland |
First Address | Clemmons, NC 27012-9150 |
Second Address | Clemmons, NC 27012-9150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 11/05/2013 |