NPI | 1285903203 |
---|---|
Former Name | AMANDA LYNN ENGELDRUM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW110773) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2011-12-20 |
Last Update Date | 2022-10-20 |