Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 824668 | FL |
NPI | 1205240058 |
---|---|
Provider Name | Martine Richardson |
First Address | Seffner, FL 33584 |
Second Address | Seffner, FL 33584-6489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 19/06/2014 |