| NPI | 1043570484 |
|---|---|
| Former Name | SAMANTHA NICOLE MONTIJO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11630) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2012-05-18 |