Name | Value |
---|---|
PROVIDER TYPE | Behavioral Health and Social Service |
CLASSIFICATION | Psychoanalyst |
STATUS | Inactive |
DATE INACTIVATED | 2005-11-15 00:00:00 |
VA CODE | V010300 |
INDIVIDUAL/NON | INDIVIDUAL |
MASTER ENTRY FOR VUID | YES |
VUID | 5252423 |
EFFECTIVE DATE/TIME |
|