| NPI | 1255670501 |
|---|---|
| Former Name | SAMANTHA VAN ORNUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16581130) |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2019-02-15 |