NPI | 1467148213 |
---|---|
Former Name | SHELLEY WATERMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022049325) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 04107) |
Enumeration Date | 2023-04-14 |
Last Update Date | 2023-04-14 |