| NPI | 1235775206 |
|---|---|
| Former Name | LIDDIA THORNTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11667) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2019-11-25 |