Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003221144 |
---|---|
Provider Name | Mrs. Dustin Leigh Shandy |
First Address | Clarksville, TN 37043-4539 |
Second Address | Clarksville, TN 37043-4539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 27/06/2014 |