Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 11137215 | GA |
NPI | 1063818664 |
---|---|
Provider Name | Miss Marta Greer |
First Address | Stockbridge, GA 30281-4222 |
Second Address | Stockbridge, GA 30281-4222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2014 |
Last Update Date | 08/11/2014 |