Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003264649 |
---|---|
Provider Name | Ta'erica Manuel |
First Address | Winnsboro, LA 71295-3636 |
Second Address | Winnsboro, LA 71295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 14/06/2018 |