| NPI | 1376792622 |
|---|---|
| Former Name | ALISA JO EDGERTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 4262) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 8541) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2025-01-27 |