Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904007288 | VA |
NPI | 1003132135 |
---|---|
Provider Name | Ms. Charon Dubose |
First Address | Newport News, VA 23601-1426 |
Second Address | Hampton, VA 23666-2430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 14/04/2010 |