| 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 |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2024-09-25 |