Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ADC-010765-2015 | FL |
NPI | 1003275678 |
---|---|
Provider Name | Stephanie Cheryl Bosh |
First Address | Jacksonville, FL 32254-3582 |
Second Address | Jacksonville, FL 32254-3582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2016 |
Last Update Date | 11/02/2016 |