| NPI | 1033589320 |
|---|---|
| Former Name | IDELLMAR BYAIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 1-02103) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-09-30 |