Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 0000 | GA |
NPI | 1306476296 |
---|---|
Provider Name | Turrender Meshell Bates |
First Address | Augusta, GA 30904-5726 |
Second Address | Augusta, GA 30904-5726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2020 |
Last Update Date | 21/01/2020 |