| NPI | 1316351778 |
|---|---|
| Former Name | JAMIE LYNN BULLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2014015460) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 7924) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-11-18 |