| NPI | 1346625134 |
|---|---|
| Former Name | SELENE LOPEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2023-06-28 |