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 |