Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | MFT000798 | GA |
NPI | 1225064652 |
---|---|
Provider Name | Ms. Deborah D Wight-Knight |
First Address | Warner Robins, GA 31093-3347 |
Second Address | Warner Robins, GA 31093-3213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 08/07/2007 |