| NPI | 1093482176 |
|---|---|
| Former Name | AMANDA BAGWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0019895) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0019895) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2024-07-22 |