| NPI | 1134408180 |
|---|---|
| Former Name | CASSANDRA RUSSETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.018979) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 09028) |
| 104100000X Social Worker (Licence: IA 007999) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2021-07-10 |