| NPI | 1477822971 |
|---|---|
| Former Name | BROOKE MARIE BOUCHER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA S87458415) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2011-12-29 |