| NPI | 1588974711 |
|---|---|
| Former Name | STEPHANIE EDICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180007625) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180007625) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2025-05-06 |