| NPI | 1316221955 |
|---|---|
| Former Name | JESSICA S. STATESMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC2680) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MD LC2680) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2022-07-21 |