| NPI | 1134779366 |
|---|---|
| Former Name | KRISTOL CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC011299) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC005819) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-12-17 |