Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1306309398 |
---|---|
Provider Name | Shaletta Borders |
First Address | Ozark, AL 36360-7204 |
Second Address | Ozark, AL 36360-7204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2019 |
Last Update Date | 08/04/2019 |