| NPI | 1114095155 |
|---|---|
| Former Name | ROXANNE RAE DIRKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00004918) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA H20090) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |