NPI | 1609250240 |
---|---|
Former Name | ASHLEY KEONA SHAW |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010945) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-21606) |
101YM0800X Counselor, Mental Health (Licence: NC P009600) | |
Enumeration Date | 2015-07-14 |
Last Update Date | 2024-02-28 |