| NPI | 1083862197 |
|---|---|
| Former Name | JENNIFER LYNN PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 001059) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2015-09-18 |