| NPI | 1134965411 |
|---|---|
| Former Name | CORRINA LICON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 4240) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 230128238) |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2025-08-26 |