| NPI | 1083376289 |
|---|---|
| Former Name | MIRANDA MADISON MANEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19111) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2021-10-06 |