| NPI | 1124457460 |
|---|---|
| Former Name | KATIE JANE MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5684-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16798-130) |
| 101YM0800X Counselor, Mental Health (Licence: WI 1767-226) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2015-10-12 |