NPI | 1023614088 |
---|---|
Former Name | KATRINA REARDON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC13430) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 20041) |
Enumeration Date | 2020-12-07 |
Last Update Date | 2023-12-15 |