| NPI | 1295367076 |
|---|---|
| Former Name | GEORGIA SHULTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MT BBH-LCPC-LIC-48284) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT BBH-PCLC-LIC-42651) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2024-02-13 |