| NPI | 1326850900 |
|---|---|
| Former Name | PHYLLIS RAINES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 15258) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 15258) |
| Enumeration Date | 2025-01-22 |
| Last Update Date | 2025-01-22 |