| NPI | 1477979094 |
|---|---|
| Former Name | MARISSA RENEE DUDLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0184501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0157361) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2025-01-22 |