| NPI | 1134611239 |
|---|---|
| Former Name | ALYSSA LATONIA IDLEBURG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A13964) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-24523) |
| 101YM0800X Counselor, Mental Health (Licence: IL 178.012997) | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2018-07-17 |