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 |