| NPI | 1104350362 |
|---|---|
| Former Name | KAITLYN BETH POTTLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006746) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC5675) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2017-04-14 |