NPI | 1033514062 |
---|---|
Former Name | AUDRA JOY INGRAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: TX 69473) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 69473) |
Enumeration Date | 2014-11-04 |
Last Update Date | 2023-05-30 |