NPI | 1154743284 |
---|---|
Former Name | BREANNA CAREY TILLERY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251S00000X (Licence: MA 000224228) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 123719) |
Enumeration Date | 2014-01-08 |
Last Update Date | 2022-11-02 |