Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 1041C0700X | Clinical Social Worker | SW16920 | FL |
NPI | 1003321894 |
---|---|
Provider Name | Tina Harkness-Poirier |
First Address | Gainesville, FL 32608-4006 |
Second Address | Live Oak, FL 32064-8463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2017 |
Last Update Date | 13/05/2020 |