NPI | 1104352244 |
---|---|
Former Name | JESSICA LEE BAILEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017384) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401015890) |
Enumeration Date | 2017-05-11 |
Last Update Date | 2022-08-08 |