| NPI | 1407645211 |
|---|---|
| Former Name | KASEY LEIGH ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 5035) |
| Enumeration Date | 2025-05-06 |
| Last Update Date | 2025-05-06 |