Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1215145743 |
---|---|
Provider Name | Ms. Ruth Elaine Henderson |
First Address | Navarre, FL 32566-8933 |
Second Address | Navarre, FL 32566-8933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 06/11/2014 |