| NPI | 1053734020 |
|---|---|
| Former Name | PETTINA SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 3231) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 0000003034) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-06-16 |