| NPI | 1437680188 |
|---|---|
| Former Name | MISTY MICHELLE DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00004515) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2019-09-23 |