| NPI | 1053090894 |
|---|---|
| Former Name | BETHANY MIKKELLE LOREE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1516150723) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-07-09 |