Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 2883 | AL |
NPI | 1003119389 |
---|---|
Provider Name | Mrs. Regina Nkomo Moyo |
First Address | Birmingham, AL 35218-2221 |
Second Address | Indian Springs, AL 35124-3645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2010 |
Last Update Date | 08/12/2010 |