Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 0701003259 | VA |
Y | 101YP2500X | Professional Counselor | VA |
NPI | 1023045630 |
---|---|
Provider Name | Mrs. Bethany Lorna Mclemore |
First Address | Roanoke, VA 24018-6937 |
Second Address | Roanoke, VA 24018-6515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 16/04/2008 |