NPI | 1497455521 |
---|---|
Former Name | KIMBERLY DIANE ROGERS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 18490) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 63689) |
Enumeration Date | 2023-03-07 |
Last Update Date | 2023-03-07 |