| NPI | 1205993482 |
|---|---|
| Former Name | THERESA GRACYALNY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1941-123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 383-124) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1828-132) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2017-05-09 |