Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003025065 |
---|---|
Provider Name | Ms. Rochelle Marie Ignatz |
First Address | Clearwater, FL 34604 |
Second Address | Largo, FL 33773-1866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 18/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
762653300 | (05) | FL |