| NPI | 1205216009 |
|---|---|
| Former Name | JESSICA ALEXANDRA MAINES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1192450115) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-06-05 |