| NPI | 1083025753 |
|---|---|
| Former Name | BUFFY RENEA MIRACLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 171065) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 161500) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2017-01-16 |