NPI | 1073032819 |
---|---|
Former Name | AMANDA LEONA TRAMBLAY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61023658) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60612048) |
Enumeration Date | 2017-09-13 |
Last Update Date | 2022-07-21 |