NPI | 1407867609 |
---|---|
Former Name | ALYCE KENNEDY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: NM LMHC: 0077181) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD: 87-91) |
Enumeration Date | 2006-08-11 |
Last Update Date | 2012-10-25 |