Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | A13669 | NC |
NPI | 1013482025 |
---|---|
Provider Name | Mrs. Brittany Johnson Todd |
First Address | Winston Salem, NC 27106-5541 |
Second Address | Winston Salem, NC 27106-4739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2018 |
Last Update Date | 05/10/2018 |