NPI | 1023715620 |
---|---|
Former Name | GISELLE MARIE BOOTH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW108705) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW108705) |
Enumeration Date | 2023-02-14 |
Last Update Date | 2023-06-13 |