| 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 |