NPI | 1346569894 |
---|---|
Former Name | SARAH LYNETTE JACKSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401011852) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI L2482392) |
Enumeration Date | 2010-05-24 |
Last Update Date | 2023-04-24 |