| NPI | 1265551345 |
|---|---|
| Former Name | GLENDA KENNETTA RIVERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 4159) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC2115) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |