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Thread-Topic: Response via eform 100009 - VSP Application
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Subject: Response via eform 100009 - VSP Application
Date: Wed, 1 Jun 2016 12:40:16 -0400
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<APP>WORKFLOW
<TEMPLATEID>350</TEMPLATEID>
<PREFIX></PREFIX>
<FIRST>Kristina</FIRST>
<MIDDLE>L</MIDDLE>
<LAST>Smith</LAST>
<ADDR2></ADDR2>
<CITY>Pickens</CITY>
<STATE>SC</STATE>
<ZIP>29671</ZIP>
<EMAIL>director@maryshouse.com</EMAIL>
<PHONE_B>864-855-1708</PHONE_B>
<ADDR1>P.O. Box 132</ADDR1>
<TITLE>Executive Director</TITLE>
<ORGANIZATION>MARYS House (Ministry Alliance for Regaining Your Safety)</ORGANIZATION>
<WFUD_DateHire>09/07/2022</WFUD_DateHire>
<WFUD_County>Pickens</WFUD_County>
<WFUD_Muncipality>Easley</WFUD_Muncipality>
<WFUD_JudCircuit>13th Cir</WFUD_JudCircuit>
<WFUD_Employment>Private/Non Profit Organization</WFUD_Employment>
<WFUD_Credentialing>Basic VSP</WFUD_Credentialing>
<ADDL_PEOPLE>
<PREFIX>Mrs</PREFIX>
<FIRST>Grace</FIRST>
<MIDDLE>A</MIDDLE>
<LAST>Edwards</LAST>
<EMAIL>graceedwards@greenvillecounty.org</EMAIL>
<ORGANIZATION>MARYS House</ORGANIZATION>
<PHONE_B>864-898-5631</PHONE_B>
<TITLE>Board of Directors Chairman</TITLE>
</ADDL_PEOPLE>
<SUBJECT></SUBJECT>
<CUSTOM1>96.37.73.105</CUSTOM1>
<MSG>

</MSG>

</APP>