| NPI | 1336774421 |
|---|---|
| Former Name | DEANNA RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401016092) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: MI SC0000000934851) |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2020-03-09 |