Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 63097 | TX |
NPI | 1003586413 |
---|---|
Provider Name | Vanessa Rae King |
First Address | San Angelo, TX 76904-4269 |
Second Address | San Angelo, TX 76904-6801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2021 |
Last Update Date | 16/09/2021 |