| NPI | 1023909090 |
|---|---|
| Former Name | MARY E CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-ACLC-LIC-80869) |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-10-01 |