Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW003893 | GA |
NPI | 1003093030 |
---|---|
Provider Name | Miss Opal Hope Minott |
First Address | Lawrenceville, GA 30045-3531 |
Second Address | Lawrenceville, GA 30045-3531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286447905A | (05) | GA |