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Individual
JUSTIN SCOTT PROCTOR
Active
Individual
JUSTIN SCOTT PROCTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16918
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16918
LICENSE
MD
Enumeration date
05/17/2011
Last updated
01/27/2017
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