Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 6401009993 | MI |
Y | 101YP2500X | Professional Counselor |
NPI | 1053559369 |
---|---|
Provider Name | Ms. Linda Irene Itson |
First Address | Flint, MI 48505-6618 |
Second Address | Flint, MI 48505-6618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2009 |
Last Update Date | 08/04/2019 |