Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | TX |
NPI | 1124650478 |
---|---|
Provider Name | Mrs. Ninekia Young |
First Address | Mesquite, TX 75181-1733 |
Second Address | Mesquite, TX 75150-7009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2020 |
Last Update Date | 05/02/2020 |