NPI | 1598753121 |
---|---|
Former Name | DORNA SUE FRY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-11733) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-11733) |
Enumeration Date | 2005-10-07 |
Last Update Date | 2019-10-29 |