| NPI | 1114406097 |
|---|---|
| Former Name | STEPHANIE BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401018624) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 88420) |
| 101YP2500X Counselor, Professional (Licence: TN 6600) | |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2023-12-01 |