NPI | 1477915304 |
---|---|
Former Name | AMANDA MAY NICHOLS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006508) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39002524A) |
Enumeration Date | 2016-03-21 |
Last Update Date | 2022-09-21 |