NPI | 1003292814 |
---|---|
Former Name | AMBER LEA MEDLIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C010991) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-22213) |
1041C0700X Social Worker Clinical (Licence: NC P009827) | |
Enumeration Date | 2015-08-04 |
Last Update Date | 2019-09-05 |