| NPI | 1083121420 |
|---|---|
| Former Name | KASSANDRA JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: E.2404591) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LICDC.162035) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2024-09-19 |