NPI | 1316423304 |
---|---|
Former Name | ALEXANDRA DELOACH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LC11395) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP9603) |
Enumeration Date | 2018-07-13 |
Last Update Date | 2023-03-14 |