NPI | 1043986334 |
---|---|
Former Name | JESSICA SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CMH0215611) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2021-08-18 |
Last Update Date | 2024-05-30 |