NPI | 1356721039 |
---|---|
Former Name | SAMANTHA TILTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 10764) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
Enumeration Date | 2015-06-08 |
Last Update Date | 2022-03-02 |