Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 01981 | TX |
NPI | 1003075250 |
---|---|
Provider Name | Ms. Beverly H. Christopher |
First Address | Longview, TX 75607-7593 |
Second Address | Longview, TX 75602-2406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/06/2008 |