| NPI | 1215413646 |
|---|---|
| Former Name | NICOLE PHILLIPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 7847-125) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 7847-125) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2024-11-04 |