NPI | 1417494923 |
---|---|
Former Name | DEBRA POMROY LUNDERGAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4636) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2016005650) |
Enumeration Date | 2017-01-22 |
Last Update Date | 2017-03-05 |