Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC000364 | GA |
NPI | 1003900796 |
---|---|
Provider Name | Susan Spence |
First Address | Atlanta, GA 30338 |
Second Address | Atlanta, GA 30338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |