| NPI | 1114125978 |
|---|---|
| Former Name | JENNIFER MAVRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8176) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2868) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2011-07-18 |