| NPI | 1407847403 |
|---|---|
| Former Name | NETTIE LYNNE CLEGG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM C-4453) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 4198) |
| 101YM0800X Counselor, Mental Health (Licence: NM I4453) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2020-09-09 |