| NPI | 1326610882 |
|---|---|
| Former Name | KRISTEN BLAIRE ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0732007746) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0709024028) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |