NPI | 1154995884 |
---|---|
Former Name | MADISON HOPE MCGONIGAL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ND 1063-5-1-20-480) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1942) |
Enumeration Date | 2021-05-17 |
Last Update Date | 2023-02-13 |