| NPI | 1396869640 |
|---|---|
| Former Name | JACKIE M TOLLARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 11671-132) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 126766-121) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |