| NPI | 1033536321 |
|---|---|
| Former Name | MARY CRUDUP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-02275) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401007949) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2024-06-27 |