| NPI | 1437833324 |
|---|---|
| Former Name | PATRICIA DIANE CLUCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1632) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-12 |