NPI | 1477836799 |
---|---|
Former Name | LORI ANN WHITE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TS0200X Psychologist, School (Licence: AZ 4207) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 4207) |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AZ 4207) | |
Enumeration Date | 2011-09-22 |
Last Update Date | 2011-09-27 |