| NPI | 1508614298 |
|---|---|
| Former Name | MILDRED GAYAMO TUPE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 18116) |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2024-05-08 |