Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1174949259 |
---|---|
Provider Name | Mr. Anthony Wade Pullen JR. |
First Address | Columbus, OH 43215-4206 |
Second Address | Columbus, OH 43215-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2014 |
Last Update Date | 14/03/2014 |