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Thread-Topic: Response via eform 100009 - VSP Application
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Subject: Response via eform 100009 - VSP Application
Date: Tue, 17 Jan 2017 16:32:35 -0500
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<APP>WORKFLOW
<TEMPLATEID>350</TEMPLATEID>
<PREFIX>Mr.</PREFIX>
<FIRST>John</FIRST>
<MIDDLE>J</MIDDLE>
<LAST>Rodriguez</LAST>
<ADDR2>MSC 861, IOP 2 South, BA 203</ADDR2>
<CITY>Charleston</CITY>
<STATE>SC</STATE>
<ZIP>29425</ZIP>
<EMAIL>rodrigjo@musc.edu</EMAIL>
<PHONE_B>843-792-2395</PHONE_B>
<ADDR1>67 President Street</ADDR1>
<TITLE>Human Services Coordinator II</TITLE>
<ORGANIZATION>National Crime Victims Research and Treatment Center</ORGANIZATION>
<WFUD_DateHire>12/05/2016</WFUD_DateHire>
<WFUD_County>Charleston</WFUD_County>
<WFUD_Muncipality>Charleston</WFUD_Muncipality>
<WFUD_JudCircuit>9th Cir</WFUD_JudCircuit>
<WFUD_Employment>Private/Non Profit Organization</WFUD_Employment>
<WFUD_Credentialing>Basic VSP</WFUD_Credentialing>
<ADDL_PEOPLE>
<PREFIX>Ms.</PREFIX>
<FIRST>Megan</FIRST>
<MIDDLE>M</MIDDLE>
<LAST>Wallace</LAST>
<EMAIL>wallam@musc.edu</EMAIL>
<ORGANIZATION>National Crime Victims Research and Treatment Center</ORGANIZATION>
<PHONE_B>843-792-8964</PHONE_B>
<TITLE>Clinic Coordinator</TITLE>
</ADDL_PEOPLE>
<SUBJECT></SUBJECT>
<CUSTOM1>128.23.49.43</CUSTOM1>
<MSG>

</MSG>

</APP>