Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | NC | |
Y | 101YP2500X | Professional Counselor | 4438 | TN |
NPI | 1003119025 |
---|---|
Provider Name | Valorie Caprice Bronstone |
First Address | Bon Aqua, TN 37025-5019 |
Second Address | Bon Aqua, TN 37025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2010 |
Last Update Date | 15/08/2019 |