| NPI | 1609174192 |
|---|---|
| Former Name | NICOLE JUSTINE MASSEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071008745) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180.008385) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2021-09-08 |