| NPI | 1063701910 |
|---|---|
| Former Name | KENIA VIDAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37CA00071000) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 17340) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2011-03-31 |