Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1063189744 |
---|---|
Provider Name | Taneka Butts |
First Address | Salisbury, MD 21804-3918 |
Second Address | Salisbury, MD 21801-4701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 30/08/2021 |