Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | IMH 6160 | FL |
NPI | 1003140435 |
---|---|
Provider Name | Ms. Genette Mary Phelps |
First Address | Martinez, GA 30907-9759 |
Second Address | Martinez, GA 30907-9759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2009 |
Last Update Date | 02/10/2009 |