| NPI | 1073062253 |
|---|---|
| Former Name | KASSANDRA ENID BAECKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 34447) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2020-12-24 |