| NPI | 1134391550 |
|---|---|
| Former Name | NYSHAUNTE M. BULLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3890) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2024-11-07 |