NPI | 1083098974 |
---|---|
Former Name | AMANDA RICKARD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003907) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 290448) |
Enumeration Date | 2015-07-10 |
Last Update Date | 2024-09-04 |