| NPI | 1124801675 |
|---|---|
| Former Name | CANDICE SHERELLE BLACKNALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2024-03-18 |