| NPI | 1063653616 |
|---|---|
| Former Name | JEANNETTE MAE MEZZO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60401133) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP60115601) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2015-12-11 |