| NPI | 1023501459 |
|---|---|
| Former Name | STACIA ROSE KING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 222776) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2020-08-18 |