| NPI | 1316273055 |
|---|---|
| Former Name | ALEXIS LAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019825) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW127241) |
| Enumeration Date | 2009-11-01 |
| Last Update Date | 2019-10-15 |