NPI | 1053520163 |
---|---|
Former Name | ALYSON SHEA GRAHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 5072) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 931) |
Enumeration Date | 2007-05-22 |
Last Update Date | 2015-08-10 |