Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | DC |
NPI | 1023598927 |
---|---|
Provider Name | Shannon Faye Waters |
First Address | Washington, DC 20002-6806 |
Second Address | Washington, DC 20002-1519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 20/08/2018 |