| NPI | 1225402175 |
|---|---|
| Former Name | SHANNON NICOLE MILLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO .09925711) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 68800) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2021-01-27 |