Doctor Name: | DR. JEFF RANDALL MISHOE |
NPI Number: | 1003067695 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.MIN. |
License Number: | 15 |
Business Practice Address: | 310 East Blvd C-8 Charlotte, NC - 282034891 |
Business Phone Number: | 7043441100 |
Business Fax Number: | 7043441100 |
Mailing Address: | 310 East Blvd, C-8 CHARLOTTE |
State: | NC |
Postal Code: | 282034891 |
Phone Number: | 7043441100 |
Fax Number: | 7043441100 |
NPI Enumeration Date: | 10/01/2008 |
NPI Last Update Date: | 10/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | 15 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |