Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1255866422 |
---|---|
Provider Name | Luevonia Payton |
First Address | Fayetteville, GA 30214-6524 |
Second Address | Fayetteville, GA 30215-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2017 |
Last Update Date | 20/09/2021 |