| NPI | 1104009901 |
|---|---|
| Former Name | LEEANNA MARIE CASTOR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1397900720) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2020-08-12 |