| NPI | 1164069829 |
|---|---|
| Former Name | DAVETTA A CARLISLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 91192) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39003653A) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2024-03-22 |