NPI | 1548715006 |
---|---|
Former Name | SHANNON BROCK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW84280) |
Additional Taxonomies | 101Y00000X Counselor |
104100000X Social Worker | |
Enumeration Date | 2016-08-24 |
Last Update Date | 2019-04-02 |