| NPI | 1023377561 |
|---|---|
| Former Name | KERSTIN NICOLE MANDERSON-SIDNEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LCS29222) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW23055) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2017-01-17 |