NPI | 1164575155 |
---|---|
Former Name | AMANDA LEIGH MICHELICH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 5421) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 5421) |
251S00000X (Licence: NC 5421) | |
Enumeration Date | 2007-01-21 |
Last Update Date | 2022-06-06 |