NPI | 1407073570 |
---|---|
Former Name | ADDISON SANDEL BAXTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: LA 349) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: LA 349) |
Enumeration Date | 2007-04-19 |
Last Update Date | 2007-07-08 |