Individual
PORSCHE PROWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31906-4328
(706) 596-5575
Mailing address
P.O. BOX 5328, COLUMBUS, GA 31906-4328
(706) 596-5575
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
104100000X
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104100000X
—
GA
Enumeration date
03/14/2014
Last updated
03/14/2014
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