Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC14109 | AZ |
NPI | 1003239138 |
---|---|
Provider Name | Ms. Deborah Kay Carson |
First Address | Prescott, AZ 86305-1109 |
Second Address | Prescott, AZ 86305-1109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2014 |
Last Update Date | 24/01/2014 |