NPI | 1609305549 |
---|---|
Former Name | PHYLICIA WILLIAMS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 8399) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2017-06-05 |
Last Update Date | 2023-10-17 |