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 |