| NPI | 1417472630 |
|---|---|
| Former Name | GRACE JESSIE RAULSTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10837) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2017-08-09 |