| NPI | 1265450886 |
|---|---|
| Former Name | ANDREA L PENNOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 3910) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS 198) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2017-10-15 |