| NPI | 1104429612 |
|---|---|
| Former Name | MADDIE MARIE FAKLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2021-11-22 |