| NPI | 1295416295 |
|---|---|
| Former Name | BRANDI LAINE ROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci37760323) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2023-07-31 |