| NPI | 1003574229 |
|---|---|
| Former Name | JACQUELINE MITCHELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 28071) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 28071) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904017476) | |
| Enumeration Date | 2021-12-05 |
| Last Update Date | 2026-02-06 |