| NPI | 1306476528 |
|---|---|
| Former Name | KELLY OLENA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC011270) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 12303) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2020-07-27 |