| NPI | 1235795485 |
|---|---|
| Former Name | JESSICA ROSE WALD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1853) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2019-12-03 |