NPI | 1609394592 |
---|---|
Former Name | DANIELLE GRACE FETTY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: UT 9811095-2501) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: UT 98110952501) |
Enumeration Date | 2017-08-31 |
Last Update Date | 2023-09-15 |