| NPI | 1023258449 |
|---|---|
| Former Name | NICOLE KOSTAKEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180007600) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178005304) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2020-07-29 |