Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1205164407 |
---|---|
Provider Name | Mr. Richard Thomas Green |
First Address | Huntington, WV 25704-9300 |
Second Address | Huntington, WV 25704-9300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2009 |
Last Update Date | 27/11/2009 |