NPI | 1548427347 |
---|---|
Former Name | LISA CLARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CAS CO409281508) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA c058030618) |
Enumeration Date | 2008-05-20 |
Last Update Date | 2022-03-17 |