Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 1779 | MS |
NPI | 1003242264 |
---|---|
Provider Name | Patricia Busby-Robinson |
First Address | Greenwood, MS 38935-1312 |
Second Address | Greenwood, MS 38930-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2013 |
Last Update Date | 25/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01684361 | (05) | MS |