Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | APC0005348 | GA |
N | 101YP2500X | Professional Counselor | APC-0005348 | GA |
N | 101YS0200X | School Counselor | 793694 | GA |
NPI | 1053899757 |
---|---|
Provider Name | Ms. Ana Lyllian Guadalupe Menjivar-Couch |
First Address | Carrollton, GA 30116-9783 |
Second Address | Carrollton, GA 30116-9783 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2018 |
Last Update Date | 03/08/2018 |