| NPI | 1215396916 |
|---|---|
| Former Name | MARISSA JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 4767) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH c.1500150) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2020-01-07 |