| NPI | 1396272563 |
|---|---|
| Former Name | KIMBERLY MICHELLE VAN DE WATER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60785788) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2025-03-27 |