| NPI | 1134569361 |
|---|---|
| Former Name | KIMBERLY DAWN NIZNIK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10468) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2013-07-02 |