| NPI | 1356857023 |
|---|---|
| Former Name | KRISTIN WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16235) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 4079) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2021-10-05 |