| NPI | 1326291170 |
|---|---|
| Former Name | STACEY MICHELLE BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 22263) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2009-07-22 |