| NPI | 1518290527 |
|---|---|
| Former Name | MARCKDALINE ST. FORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2023-02-12 |