Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor |
NPI | 1003353194 |
---|---|
Provider Name | Shelena White |
First Address | Jonesboro, AR 72401-7213 |
Second Address | Jonesboro, AR 72401-7213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2017 |
Last Update Date | 17/03/2018 |