| NPI | 1407464688 |
|---|---|
| Former Name | BROOK ALEXIS FULTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC12594) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP10581) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2022-11-16 |