NPI | 1144748930 |
---|---|
Former Name | AMANDA CARROLL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2015040579) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2015040579) |
Enumeration Date | 2017-09-01 |
Last Update Date | 2025-02-25 |