Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003239419 |
---|---|
Provider Name | Vanessa Washington |
First Address | Senatobia, MS 38668-1735 |
Second Address | Oxford, MS 38655-5392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2014 |
Last Update Date | 22/01/2014 |