| NPI | 1295178051 |
|---|---|
| Former Name | TERESA THORN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 5972-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1369-226) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2016-11-16 |