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 |