NPI | 1376970491 |
---|---|
Former Name | KIANA MACKIE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW16051) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2013-10-03 |
Last Update Date | 2021-09-02 |