| NPI | 1396258414 |
|---|---|
| Other Name | MARTIE L. FAGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 00181-LC) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2018-03-17 |