| NPI | 1508881772 |
|---|---|
| Former Name | MIRANDA MAY SHALLOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 18736-130) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 9668-120) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-11-20 |