| NPI | 1275259665 |
|---|---|
| Former Name | STACI JACOBSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101200000X Drama Therapist (Licence: NY 002410-01) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 002410) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2024-07-17 |