| NPI | 1164990495 |
|---|---|
| Former Name | STACEY J ROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39003081A) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IN 39003081A) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2024-02-13 |