| NPI | 1104500545 |
|---|---|
| Former Name | THERESA DRAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 11874-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7467-226) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-07-02 |