| NPI | 1548259658 |
|---|---|
| Former Name | CYNTHIA LEE DESTICHE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2007-07-08 |