| NPI | 1437883840 |
|---|---|
| Former Name | AMILY ROSE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 306364) |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2024-12-24 |