| NPI | 1265901060 |
|---|---|
| Former Name | MICHELLE DIEDRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 16095) |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2018-11-21 |