| NPI | 1578239851 |
|---|---|
| Former Name | NICOLE SQUIRES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 132198-121) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2023-12-04 |