Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 225CX0006X | Orientation and Mobility Training Provider | 5731 | LA |
NPI | 1952793531 |
---|---|
Provider Name | Vanessa Martin |
First Address | Greenwell Springs, LA 70739-3112 |
Second Address | Greenwell Springs, LA 70739-3112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2015 |
Last Update Date | 11/07/2016 |