Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1194329722 |
---|---|
Provider Name | Samir Nagi Khalil |
First Address | Cleveland, TN 37312-4886 |
Second Address | Cleveland, TN 37312-4886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2020 |
Last Update Date | 24/11/2020 |