Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 21232 | GA |
NPI | 1265046858 |
---|---|
Provider Name | Yvette Wright Etheridge |
First Address | Hampton, GA 30228-2099 |
Second Address | Hampton, GA 30228-2099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 01/09/2020 |