Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 1611 | WV |
N | 101YM0800X | Mental Health Counselor | 1611 | WV |
N | 101YP1600X | Pastoral Counselor | 1611 | WV |
N | 101YP2500X | Professional Counselor | 1611 | WV |
N | 104100000X | Social Worker | AP00941711 | WV |
NPI | 1356463830 |
---|---|
Provider Name | Mrs. Joan Fernandes |
First Address | Charleston, WV 25301-2402 |
Second Address | Charleston, WV 25301-2402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |