| NPI | 1336543313 |
|---|---|
| Former Name | SHANNON MARIE MALBURG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401014409) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 1336543313) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2024-10-02 |