NPI | 1518394097 |
---|---|
Former Name | JESSICA HAWKINS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-004991) |
Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-004991) |
Enumeration Date | 2013-09-30 |
Last Update Date | 2020-12-28 |