NPI | 1508102294 |
---|---|
Former Name | KRISTEN KEHAULANI MARCIEL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003650) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 8682) |
103T00000X Psychologist (Licence: FL PY8682) | |
Enumeration Date | 2012-12-27 |
Last Update Date | 2013-05-13 |