| NPI | 1154148518 |
|---|---|
| Former Name | MELISSA JEAN EVANS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 29298) |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2024-09-25 |