| NPI | 1114687407 |
|---|---|
| Former Name | MANDIE LYNN MARTINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 132882-121) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 16622-131) |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2023-10-03 |