Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1215527726 |
---|---|
Provider Name | Mr. Winston Diondre Stanford |
First Address | Centerville, GA 31028-1410 |
Second Address | Cookeville, TN 38501-5066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2021 |
Last Update Date | 20/01/2021 |