| NPI | 1245890979 |
|---|---|
| Former Name | SHELLIE MARIE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2019031206) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2024-06-26 |