| NPI | 1043631302 |
|---|---|
| Former Name | KIMBERLY ELIZABETH HANSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP60097366) |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2015-04-09 |