| NPI | 1063095123 |
|---|---|
| Former Name | KRISTEN SOUTHWORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACA.0008458) |
| Additional Taxonomies | 172A00000X Driver |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2025-03-10 |