| NPI | 1366818874 |
|---|---|
| Former Name | ISABELLE MARIE SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP60519010) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |