Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | A10753 | NC |
N | 225C00000X | Rehabilitation Counselor | 00117504 | NC |
NPI | 1255862405 |
---|---|
Provider Name | Marina J. Vendrillo |
First Address | Clemmons, NC 27012-7725 |
Second Address | Clemmons, NC 27012-7725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 21/03/2017 |