| NPI | 1174812275 |
|---|---|
| Former Name | CONNIE JEAN BROOKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 4835) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 920) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2011-03-30 |