| NPI | 1033603527 |
|---|---|
| Former Name | ABIGAIL RAE CHARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305134) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2024-04-19 |