NPI | 1073893392 |
---|---|
Former Name | KATRINA DAHL WILBURN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801097572) |
Additional Taxonomies | 104100000X Social Worker |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2011-08-17 |
Last Update Date | 2019-06-10 |