| NPI | 1033730627 |
|---|---|
| Former Name | KARLENE CHANELL WOLLISTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 28188) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 5167) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2022-07-11 |