| NPI | 1194269779 |
|---|---|
| Former Name | MURANDA WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK 116225) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 4092) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2016-12-15 |