| NPI | 1609380179 |
|---|---|
| Former Name | THERESA VEGA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010392) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-16965) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2023-03-22 |