| NPI | 1174087258 |
|---|---|
| Former Name | LEAH RODERICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 4090) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL C2697a) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-05-20 |