NPI | 1184731341 |
---|---|
Former Name | ROBERTA SHIRLEY VONDRAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 20287) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180004019) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2007-07-08 |