| NPI | 1023523032 |
|---|---|
| Former Name | TRACY WALSH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 168712) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 165242) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2019-07-23 |