NPI | 1508358334 |
---|---|
Former Name | BREEANNE CHISM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 104132) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 84248) |
Enumeration Date | 2018-06-06 |
Last Update Date | 2023-10-11 |