| NPI | 1558882423 |
|---|---|
| Former Name | ELIZABETH MATLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801101083) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2019-12-20 |