NPI | 1508376120 |
---|---|
Former Name | AMANDA HUSAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN LSW0000007113) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW13974) |
1041C0700X Social Worker, Clinical (Licence: GA CSW006796) | |
Enumeration Date | 2017-10-10 |
Last Update Date | 2019-11-07 |