| NPI | 1215751664 |
|---|---|
| Former Name | KATHLEEN LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20558-130) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: NC 13256) |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-12 |