| NPI | 1104255637 |
|---|---|
| Other Name | DACIA LEE ANTISTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-30076) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1930) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT LAC-LAC-LIC-1930) | |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2024-03-14 |