NPI | 1588997753 |
---|---|
Former Name | ALICIA LUCKEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4621) |
Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 4621) |
Enumeration Date | 2009-09-04 |
Last Update Date | 2024-09-03 |