NPI | 1184323081 |
---|---|
Former Name | LARA KATHERINE FAIRBANKS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 221700000X Art Therapist (Licence: 22-333) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019416) |
Enumeration Date | 2023-02-28 |
Last Update Date | 2023-02-28 |