| NPI | 1114357076 |
|---|---|
| Former Name | AMY LOU FORNASIER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60416435) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60407511) |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2013-11-13 |