| NPI | 1447972278 |
|---|---|
| Former Name | KIMBERLY LOUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ 21174) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 15353) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2023-02-07 |