| NPI | 1376056473 | 
|---|---|
| Former Name | KRISTIN MCBRIDE | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-10344)  | 
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-10344)  | 
| Enumeration Date | 2017-11-10 | 
| Last Update Date | 2023-01-20 |