Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | A9622 | NC |
N | 101YS0200X | School Counselor | NC |
NPI | 1104268291 |
---|---|
Provider Name | Mrs. Lynette Boyce Dover |
First Address | Forest City, NC 28043-2801 |
Second Address | Forest City, NC 28043-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 18/07/2013 |