| NPI | 1235606047 |
|---|---|
| Former Name | KATRINA LAINE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61018956) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00006091) |
| 101Y00000X Counselor (Licence: WA CG60456610) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2021-03-10 |