NPI | 1124484928 |
---|---|
Former Name | LAUREN ROBERTS STIDGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 3751) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 3751) |
101Y00000X Counselor (Licence: AL C2514A) | |
Enumeration Date | 2016-01-08 |
Last Update Date | 2019-03-15 |