Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | C004558 | NC |
NPI | 1003081431 |
---|---|
Provider Name | Ms. Rebecca Ann Drake |
First Address | Surf City, NC 28445-6952 |
Second Address | Jacksonville, NC 28546-5226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2008 |
Last Update Date | 03/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206391300 | (05) | MD |
665373 | (02) |