NPI | 1417300880 |
---|---|
Former Name | KRISTINE CELONA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 115180) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 115180) |
Enumeration Date | 2016-07-20 |
Last Update Date | 2019-04-24 |