| NPI | 1528330784 |
|---|---|
| Former Name | ELIZABETH K GONSTEAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16052-132) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5447-125) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2016-08-29 |