NPI | 1124570577 |
---|---|
Former Name | VICTORIA GRACE HARGENRADER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006808) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000432) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102973) | |
Enumeration Date | 2016-11-02 |
Last Update Date | 2022-05-09 |