| NPI | 1548793938 |
|---|---|
| Former Name | LISA MARIE BURKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2018030575) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 03500) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2023-11-09 |