| NPI | 1306311899 |
|---|---|
| Former Name | JENNIFER ANN MCCRACKEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA 60858642) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2019-04-10 |