| NPI | 1588987465 |
|---|---|
| Former Name | JILL COSTELLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-00413) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401010625) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2022-08-30 |