| NPI | 1417715715 |
|---|---|
| Former Name | TARA CRIDDLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 225700000X Massage Therapist | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-07-31 |