| NPI | 1295512002 |
|---|---|
| Former Name | LIISA MARIE BUSHY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20339-130) |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-09-14 |