Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 12142016 | GA |
NPI | 1053785501 |
---|---|
Provider Name | Mrs. Nancy E Grabe |
First Address | Marietta, GA 30068-2418 |
Second Address | Marietta, GA 30068-2418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2015 |
Last Update Date | 24/01/2022 |