NPI | 1154923027 |
---|---|
Former Name | BROOKLYNN SAMANTHA DIMIT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401020281) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2020-11-14 |
Last Update Date | 2022-07-08 |