| NPI | 1194136309 |
|---|---|
| Former Name | REBECCA JO DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701005635) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 2949-125) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2014-05-12 |