NPI | 1356757900 |
---|---|
Former Name | DESERI ALICIA JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2016035950) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2014022296) |
Enumeration Date | 2014-07-03 |
Last Update Date | 2019-03-22 |