Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MA |
NPI | 1003166950 |
---|---|
Provider Name | Ms. Kim Christine Spooner |
First Address | New Bedford, MA 02740-1739 |
Second Address | Hyannis, MA 02601-1839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 18/09/2012 |