| NPI | 1578929253 |
|---|---|
| Former Name | STEPHANIE WATSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC8383) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP6823) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2023-03-28 |