Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1093074023 |
---|---|
Provider Name | Serge Djimi |
First Address | Norman, OK 73071-2195 |
Second Address | Norman, OK 73071-2195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 24/02/2015 |