| NPI | 1558807628 |
|---|---|
| Former Name | COURTNEY KAY TABB |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 604) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2017-01-13 |