| NPI | 1578202701 |
|---|---|
| Former Name | TRACIE BOWMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0997155) |
| Enumeration Date | 2022-06-04 |
| Last Update Date | 2022-06-04 |