| NPI | 1386204634 |
|---|---|
| Former Name | CARLY IRENE ONTKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.173221) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2025-01-15 |