Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 4844 | TX |
NPI | 1235361437 |
---|---|
Provider Name | Linda Carter |
First Address | Cordele, GA 31015-9604 |
Second Address | Cordele, GA 31015-9604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 20/08/2009 |