| NPI | 1023216645 |
|---|---|
| Former Name | CONNIE MARIE COWLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1116) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: 4622) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2008-05-14 |