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 | 1041C0700X Social Worker Clinical |
101YM0800X Counselor Mental Health | |
Enumeration Date | 2007-03-19 |
Last Update Date | 2007-07-08 |