| NPI | 1275136582 |
|---|---|
| Former Name | BEVERLY LAIDLOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 0704009795) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2020-11-21 |