Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003075342 |
---|---|
Provider Name | Quincie K. Burgess |
First Address | Waianae, HI 96792-3128 |
Second Address | Waianae, HI 96792-2645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 08/12/2010 |