| NPI | 1255602447 |
|---|---|
| Former Name | MICKEY AMBROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-11785) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-10618) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2019-09-03 |