| NPI | 1548542970 |
|---|---|
| Former Name | STACY BALLAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1000135) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1000135) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2023-06-23 |