Pancho - KIN-NID-62

Code: KIN-NID-62
Mercy ID: V-01769-01
Encounter Date: 12/01/2004
Last: King
First: Nidia
DOB: 08/31/1962
County: Clayton
Street: 950 Lake Ridge Pkwy # 1101
City: Riverdale
State: GA

Zip

30296-

Home

(770) 369-1016

Cell

(404) 454-7908

Family Status

Single adult

COB

Dominican Rep

Gender

Female

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	N/A	N/A	N/A
Father	N/A	N/A	N/A
Step Parent	N/A	N/A	N/A

Driver: YES
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: G. Landeros
Data Entry: K. Aleman