NPI | 1417251406 |
---|---|
Former Name | CAROLINE C WALL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC12038) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2011-01-05 |
Last Update Date | 2022-01-26 |