Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1124504253 |
---|---|
Provider Name | Ms. Carol Elizabeth Richardson |
First Address | Rockville, MD 20851-2446 |
Second Address | Rockville, MD 20851-2446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
EHB205 | HOLISTIC SERVICES AGENCY (01) | |
HE304 | HOLISTIC SERVICES AGENCY (01) |