Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC011775 | GA |
NPI | 1003415498 |
---|---|
Provider Name | Ms. Danielle Monique' Emina |
First Address | Ellenwood, GA 30294-1313 |
Second Address | Ellenwood, GA 30294-1313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2020 |
Last Update Date | 19/10/2020 |