NPI | 1548541048 |
---|---|
Former Name | SHANNA BROOKE DULEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NC 5173) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL PY 8953) |
Enumeration Date | 2011-08-29 |
Last Update Date | 2023-11-27 |