| NPI | 1184904864 |
|---|---|
| Former Name | GWENDOLYN KAYE RANDOLPH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 03-07-35) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2019-05-31 |