Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | KY1031 | KY |
NPI | 1003113648 |
---|---|
Provider Name | Mrs. Renita Joyce Tackett |
First Address | Pikeville, KY 41501 |
Second Address | Pikeville, KY 41501-8944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2011 |
Last Update Date | 20/08/2015 |