NPI | 1588246789 |
---|---|
Former Name | JESSICA SLOVER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180013544) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IA 106271) |
Enumeration Date | 2021-04-27 |
Last Update Date | 2024-04-23 |