Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1003459843 |
---|---|
Provider Name | Sarah Elizabeth Novak |
First Address | Lagrange, GA 30240-5754 |
Second Address | Newnan, GA 30263-1209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2019 |
Last Update Date | 24/10/2019 |