Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 1894 | GA |
NPI | 1033585146 |
---|---|
Provider Name | Ms. Arie Luvenia Bradford |
First Address | Savannah, GA 31404-2804 |
Second Address | Savannah, GA 31404-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 23/10/2020 |