| NPI | 1245955996 |
|---|---|
| Former Name | LIBBY A DETRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19480-130) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5051-226) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-10-17 |