Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003003245 |
---|---|
Provider Name | Mrs. Rebekah Good Doreau |
First Address | Chattanooga, TN 37421-1894 |
Second Address | Chattanooga, TN 37421-1894 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 03/01/2011 |