| NPI | 1104551803 |
|---|---|
| Former Name | ANNA MAE EVANGELINE CONRAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW108530) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW108530) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2022-07-20 |