Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0016701 | NY |
NPI | 1003181017 |
---|---|
Provider Name | Mr. Haines Lockhart III |
First Address | Macedon, NY 14502-8949 |
Second Address | Macedon, NY 14502-8949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2012 |
Last Update Date | 09/03/2012 |