Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1073289138 |
---|---|
Provider Name | Miss Mikayla Janae Drymond |
First Address | Tampa, FL 33624-1558 |
Second Address | Tampa, FL 33606-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2021 |
Last Update Date | 19/08/2021 |