NPI | 1134510191 |
---|---|
Former Name | COREY LAYNE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC008253) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC008253) |
103T00000X Psychologist (Licence: FL SS1424) | |
Enumeration Date | 2015-02-12 |
Last Update Date | 2019-02-12 |