Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | SC |
NPI | 1306129879 |
---|---|
Provider Name | Rickey Gene Ayers |
First Address | Columbia, SC 29206 |
Second Address | Columbia, SC 29206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2011 |
Last Update Date | 21/09/2011 |