| NPI | 1053567834 |
|---|---|
| Former Name | CHRISTINA MARIE CAVANAUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IN 39002270A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS 1906) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2015-10-15 |