Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 3795 | KY |
NPI | 1922433291 |
---|---|
Provider Name | Ms. Annie Gray-Dalton |
First Address | Calhoun, KY 42327-0654 |
Second Address | Calhoun, KY 42327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 26/08/2015 |