| NPI | 1447574702 |
|---|---|
| Former Name | THERESA A. CONSTANCE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 13165) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2010-03-16 |