Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2295 | AL |
NPI | 1003012485 |
---|---|
Provider Name | Mrs. Stephanie Williamson |
First Address | Fairhope, AL 36532-1575 |
Second Address | Mobile, AL 36609-1970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |