| NPI | 1285464503 |
|---|---|
| Former Name | HALEY MARIE PEDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA t24050) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2024-08-02 |