NPI | 1194709287 |
---|---|
Former Name | LORI DIANE CRUM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34003425A) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 34003425A) |
Enumeration Date | 2005-12-01 |
Last Update Date | 2014-09-03 |