Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC009763 | GA |
NPI | 1003314824 |
---|---|
Provider Name | Tania Van Rochelle-Catoe |
First Address | Marietta, GA 30062-4914 |
Second Address | Marietta, GA 30064-3499 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 26/01/2018 |