Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003072299 |
---|---|
Provider Name | Lore Earley |
First Address | Port St Lucie, FL 34952-1432 |
Second Address | Port St Lucie, FL 34952-1432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2008 |
Last Update Date | 06/08/2008 |