| NPI | 1912215260 |
|---|---|
| Former Name | GINGER LEIGH BURGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: IN 20042450A) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: IN 20042450A) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: IN 20042450A) | |
| 103TC0700X Psychologist Clinical (Licence: IN 20042450A) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: IN 20042450A) | |
| 103TF0000X Psychologist Family (Licence: IN 20042450A) | |
| 103TH0004X Psychologist Health (Licence: IN 20042450A) | |
| 103TH0100X Psychologist Health Service (Licence: IN 20042450A) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: IN 20042450A) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: IN 20042450A) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2017-09-28 |