| NPI | 1285809921 |
|---|---|
| Former Name | JODIE LYNN JACQUES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC3990) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2014-02-06 |