| NPI | 1508533399 |
|---|---|
| Former Name | JESSICA ROSE WAUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 176457) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2021-08-27 |