Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1174902332 |
---|---|
Provider Name | Nefateri Smalls |
First Address | Ridgeville, SC 29472-0231 |
Second Address | Ridgeville, SC 29472-0231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 19/11/2021 |