| NPI | 1023318813 |
|---|---|
| Former Name | LISA MICHELLE CARRILLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11182) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2012-11-05 |