| NPI | 1376913111 |
|---|---|
| Former Name | AMANDA MAIRE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 11782-c) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2025-04-02 |