NPI | 1427314814 |
---|---|
Other Name | WILLOW GALLENZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904006757) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0710102081) |
Enumeration Date | 2012-04-10 |
Last Update Date | 2012-04-10 |