NPI | 1033596077 |
---|---|
Former Name | KAITLYN ELIZABETH CANTWELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014510) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.008679) |
101YP2500X Counselor, Professional (Licence: IL 180.010378) | |
Enumeration Date | 2015-04-28 |
Last Update Date | 2018-05-03 |