| NPI | 1588918411 |
|---|---|
| Former Name | SOPHIA MARIE HOLLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 11860) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2014-03-19 |