| NPI | 1306687876 |
|---|---|
| Former Name | KIMBERLY PEACOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-155328) |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2024-06-06 |