| NPI | 1366165532 |
|---|---|
| Former Name | KRISTIN MARGARET CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE p-1677) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-09-22 |