| NPI | 1356693782 |
|---|---|
| Former Name | SAMANTHA RENEE NICHOLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61398879) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA MG61135422) |
| 101Y00000X Counselor (Licence: WA CG61135811) | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2023-10-17 |