Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003337676 |
---|---|
Provider Name | Mary Nelms |
First Address | Pompano Beach, FL 33064-6805 |
Second Address | Pompano Beach, FL 33064-6805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2017 |
Last Update Date | 04/07/2017 |