Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | GA |
NPI | 1215499074 |
---|---|
Provider Name | Ms. Lisa Macapitoguatunaniche Nyabinghi |
First Address | Norcross, GA 30093-1707 |
Second Address | Norcross, GA 30093-1707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |