| NPI | 1265827836 |
|---|---|
| Former Name | JACQUELINE PAIGE SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101006785) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-15179) |
| 106H00000X Marriage & Family Therapist (Licence: AZ LAMFT-10431) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2019-02-19 |