| NPI | 1174186233 |
|---|---|
| Former Name | SUSAN RAE PORTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180013585) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2018036478) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180013585) | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-11-13 |