Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 2277 | NC |
NPI | 1477792919 |
---|---|
Provider Name | Mrs. Eva L. Trivett-Clark |
First Address | Newland, NC 28657-9261 |
Second Address | Boone, NC 28607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2009 |
Last Update Date | 06/02/2009 |