| NPI | 1467916973 |
|---|---|
| Former Name | SHANDA LAREE WAUNEKA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ 655) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2024-02-06 |