Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003198037 |
---|---|
Provider Name | Zibe Holton |
First Address | Knoxville, TN 37917-5158 |
Second Address | Knoxville, TN 37917-5158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2011 |
Last Update Date | 15/09/2011 |