| NPI | 1518484740 |
|---|---|
| Former Name | GEORGIA ROXANNE HUSTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 83245) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2018-06-18 |