NPI | 1275187080 |
---|---|
Former Name | THERESA ELIZABETH JORDAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: ME CC6723) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 10200) |
Enumeration Date | 2019-07-30 |
Last Update Date | 2022-08-24 |