| NPI | 1306597356 |
|---|---|
| Former Name | HOLLY LYNN NUSBAUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 161664) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2022-01-11 |