Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1154617553 |
---|---|
Provider Name | Mr. Anthony Richard La Forgia |
First Address | Port Charlotte, FL 33954-1000 |
Second Address | Port Charlotte, FL 33954-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 23/06/2011 |