Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4166 | LA |
NPI | 1003161829 |
---|---|
Provider Name | Nicole Spector Leon |
First Address | Jefferson, LA 70121-4040 |
Second Address | New Orleans, LA 70119-6435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2012 |
Last Update Date | 18/07/2012 |