NPI | 1114430667 |
---|---|
Former Name | JESSICA KELLY LUCASON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C002877) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 009331) |
1041C0700X Social Worker, Clinical (Licence: CA 21347) | |
Enumeration Date | 2017-11-07 |
Last Update Date | 2018-06-16 |