| NPI | 1164143319 |
|---|---|
| Former Name | DAWN NICOLE SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20023-130) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |