| NPI | 1184112294 |
|---|---|
| Former Name | LICIA MONIQUE EMANUEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60811079) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2018-04-24 |