NPI | 1043911720 |
---|---|
Former Name | BRANDI POWELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701012275) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701012275) |
101Y00000X Counselor (Licence: VA 0701012275) | |
Enumeration Date | 2023-03-10 |
Last Update Date | 2023-03-10 |