NPI | 1538777420 |
---|---|
Former Name | TIARRA MCKINNEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180015204) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 6919) |
101YM0800X Counselor, Mental Health (Licence: IL 178015821) | |
Enumeration Date | 2020-07-16 |
Last Update Date | 2025-04-15 |