Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | ||
Y | 101YS0200X | School Counselor |
NPI | 1366904542 |
---|---|
Provider Name | Mr. Jahzuyan M Sawo |
First Address | Claymont, DE 19703-2286 |
Second Address | Claymont, DE 19703-2286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 05/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1447535422 | I DO NOT HAVE MEDICAID (01) | PA |