| NPI | 1194379784 |
|---|---|
| Former Name | JESSICA SUSAN DIAZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC11740) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LGP9764) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2021-07-28 |