NPI | 1144450966 |
---|---|
Former Name | VICTORIA MYLECRAINE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 28965) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2009-07-15 |
Last Update Date | 2019-03-15 |