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 |