| NPI | 1134565245 |
|---|---|
| Former Name | ANGELA LYNN JACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW11436) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW6712) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2023-08-01 |