Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 05187748 | FL |
NPI | 1194906388 |
---|---|
Provider Name | Mr. Charles Warren Price SR. |
First Address | Louisa, KY 41230-1701 |
Second Address | Louisa, KY 41230-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 16/11/2007 |