| NPI | 1396415121 |
|---|---|
| Former Name | AMANDA GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180014340) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 178-016094) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2023-08-31 |