| NPI | 1053306084 |
|---|---|
| Former Name | VICKY L VANDEWEERD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 9607912) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2007-07-08 |