| NPI | 1205481330 |
|---|---|
| Former Name | JENNIFER R ROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 1285053017) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2019-08-06 |