Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 1041C0700X | Clinical Social Worker | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1245824424 |
---|---|
Provider Name | Nan W Decolaines |
First Address | High Shoals, GA 30645-0143 |
Second Address | N High Shoals, GA 30621-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2021 |
Last Update Date | 27/02/2021 |