| NPI | 1164699013 |
|---|---|
| Former Name | AMANDA RENEE DOCKSTEADER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CL61519127) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00023855) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2024-05-09 |