| NPI | 1578626750 |
|---|---|
| Former Name | CHIDALE MARIE BLACKWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 8599) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YP2500X Counselor, Professional (Licence: GA LPC005525) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-12-12 |