Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701000005 | VA |
NPI | 1992725121 |
---|---|
Provider Name | Robert Becker |
First Address | Martinsville, VA 24112-2810 |
Second Address | Martinsville, VA 24112-2810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 27/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004945221 | (05) | VA |