| 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 |