NPI | 1427177484 |
---|---|
Former Name | MELBA JENINE NICHOLSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 018720) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 22925) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071006957) | |
Enumeration Date | 2007-03-28 |
Last Update Date | 2019-03-13 |