| NPI | 1568577617 |
|---|---|
| Former Name | TERI ELLEN MAWSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ND 1545) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |