Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | AL |
NPI | 1023653177 |
---|---|
Provider Name | Miss Octiavia Sharnea Mason |
First Address | Selma, AL 36701-6906 |
Second Address | Uniontown, AL 36786-2614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 13/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C3432A | (05) | AL |