Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC-0000394 | DE |
NPI | 1003174335 |
---|---|
Provider Name | Teri F Isabella |
First Address | Milford, DE 19963-6418 |
Second Address | Milford, DE 19963-6418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 24/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PC-0000394 | LICENSE (01) | DE |