| NPI | 1376847889 |
|---|---|
| Former Name | CAROLYN MARY MCCOY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 817) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2010-12-28 |