| NPI | 1588734412 |
|---|---|
| Former Name | VIRGINIA LEE TELFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 2193) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |