| NPI | 1083233514 |
|---|---|
| Former Name | LAURA JEAN VANWORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11370) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2021-04-12 |