| NPI | 1376577528 |
|---|---|
| Former Name | JESSICA ROSE BURGESS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 674) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-07-08 |