| NPI | 1245882273 |
|---|---|
| Former Name | CHARLISE TERESA PRESTWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701013441) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000673) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2024-06-26 |