NPI | 1215457403 |
---|---|
Former Name | DELANDRIA STATON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC11310) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
101YP2500X Counselor, Professional (Licence: DC PRC15383) | |
Enumeration Date | 2017-06-20 |
Last Update Date | 2023-09-15 |