NPI | 1043832504 |
---|---|
Former Name | CANDICE MARIE STEWART |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 18701) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 15132) |
Enumeration Date | 2020-05-07 |
Last Update Date | 2020-05-07 |