NPI | 1144839788 |
---|---|
Former Name | RACHAEL ANN MIEDEMA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SD LPC-MH30593) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 16091731) |
101YM0800X Counselor, Mental Health (Licence: IA 112727) | |
101YM0800X Counselor, Mental Health (Licence: SD LPC7420) | |
101YP2500X Counselor, Professional (Licence: MN cc03615) | |
Enumeration Date | 2020-07-29 |
Last Update Date | 2024-11-06 |