| NPI | 1316364938 |
|---|---|
| Former Name | OCTAVIA DIANNE MADISON-COLMORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701001856) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000584) | |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2014-03-20 |