Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003145608 |
---|---|
Provider Name | Mrs. Virginia Joyce Gatson |
First Address | Phoenix, AZ 85006-2611 |
Second Address | Phoenix, AZ 85006-2611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2009 |
Last Update Date | 10/12/2009 |