| NPI | 1073644373 |
|---|---|
| Former Name | LISA MICHELLE CICERRELLA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 131144) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2018-06-08 |