| NPI | 1285035295 |
|---|---|
| Former Name | DANIELLE GIBSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16108-131) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 2900-226) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2017-03-07 |