| NPI | 1528051117 |
|---|---|
| Former Name | JOY COLETTE FULLENKAMP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IA 04839) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 00107) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2012-10-29 |