| NPI | 1265979157 |
|---|---|
| Former Name | MICHELE L VANDERWIELEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15320) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 7620) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |