NPI | 1548094006 |
---|---|
Former Name | MELISSA DEE BRADSHAW |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4134) |
Enumeration Date | 2024-08-28 |
Last Update Date | 2024-08-28 |