Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 8160 | NY |
NPI | 1003096454 |
---|---|
Provider Name | Megan Elizabeth Liston |
First Address | Elmont, NY 11003-1603 |
Second Address | Elmont, NY 11003-1603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2007 |
Last Update Date | 13/11/2007 |