| NPI | 1598374845 |
|---|---|
| Former Name | LACEY R CLARE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0016585) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0017388) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2020-12-03 |