NPI | 1770532558 |
---|---|
Former Name | TAMMY LYNN VINZANT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: IA 000984) |
Additional Taxonomies | 103T00000X Psychologist (Licence: IA 000463) |
Enumeration Date | 2006-05-09 |
Last Update Date | 2007-12-19 |