NPI | 1134608441 |
---|---|
Former Name | TARA MARIE SEGREST |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00629900) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00285600) |
Enumeration Date | 2018-08-08 |
Last Update Date | 2024-09-25 |