| NPI | 1457617920 |
|---|---|
| Professional Name | STACI GLEE BRYSON DES RAULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 005197) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2021-09-08 |