| NPI | 1205403581 |
|---|---|
| Former Name | MARISSA KOSTICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6802091123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851118243) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2025-01-30 |