| NPI | 1205597416 |
|---|---|
| Former Name | CARLA JO WITTER LAWRENCE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 10848) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 953) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 247) | |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2022-01-10 |