NPI | 1073047783 |
---|---|
Former Name | AUDREY DAVIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 125819) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC23719) |
1041C0700X Social Worker, Clinical (Licence: CO CSW.09928823) | |
Enumeration Date | 2017-04-19 |
Last Update Date | 2025-08-05 |