| NPI | 1568956373 |
|---|---|
| Former Name | ANGELA DIANE GARDNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-18-149) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2018-06-15 |