| NPI | 1235338435 |
|---|---|
| Former Name | BEVERLY SUE TICE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1024) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2022-07-21 |