| NPI | 1407064397 |
|---|---|
| Former Name | SHAUNA MICHELLE MORAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA424) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 12380) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |