Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401017761 | MI |
NPI | 1003451667 |
---|---|
Provider Name | Ms. Karolina Jevaltaite |
First Address | Ada, MI 49301-8411 |
Second Address | Ada, MI 49301-8411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2019 |
Last Update Date | 07/11/2019 |