| NPI | 1346951340 |
|---|---|
| Former Name | STACIE RENEE GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 9496) |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2023-01-29 |