| NPI | 1245956929 |
|---|---|
| Former Name | SAMANTHA KELLY CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IN 99114518A) |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2022-10-21 |