Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 001837 | MO |
NPI | 1003130865 |
---|---|
Provider Name | Mary Ann Williamson |
First Address | Saint Louis, MO 63127-1646 |
Second Address | Saint Louis, MO 63105-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2010 |
Last Update Date | 23/03/2010 |