Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003180837 |
---|---|
Provider Name | Teresa Eddinger |
First Address | Brandon, FL 33510-4419 |
Second Address | Brandon, FL 33510-4419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2012 |
Last Update Date | 24/02/2012 |