| NPI | 1043866163 |
|---|---|
| Former Name | AMANDA LOUISE LUECKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |