NPI | 1104982859 |
---|---|
Former Name | RANDI MICHELLE HERMAN-ROGGEMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LPC-2209) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-2209) |
Enumeration Date | 2006-12-28 |
Last Update Date | 2018-09-13 |