| NPI | 1316538069 |
|---|---|
| Former Name | TIFFANY RICHARDSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-04-07 |