| NPI | 1508219007 |
|---|---|
| Former Name | ALICE LYDIA ELMER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY 083) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2021-08-17 |