| NPI | 1588119549 |
|---|---|
| Former Name | TIFFANY EDMUNDSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 12407) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-28546) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2023-08-03 |