Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | M5931 | MS |
NPI | 1003824400 |
---|---|
Provider Name | Ms. Natisha Polk |
First Address | Collins, MS 39428-1364 |
Second Address | Collins, MS 39428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |