Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1245597376 |
---|---|
Provider Name | Mrs. Desiree Love-Holliday |
First Address | Miramar, FL 33023-6029 |
Second Address | Miramar, FL 33023-6029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 13/04/2012 |