| NPI | 1548536634 |
|---|---|
| Former Name | INDIA MARIE ELSIE CHEATHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY202839) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2018-11-13 |