NPI | 1104307289 |
---|---|
Former Name | STACY JUSTICE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120039) |
Additional Taxonomies | 251S00000X Community/Behavioral Health |
Enumeration Date | 2018-08-27 |
Last Update Date | 2024-09-25 |