| NPI | 1265943294 |
|---|---|
| Former Name | JESSICA AMANDA HAYNES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |