NPI | 1609522721 |
---|---|
Former Name | JENNIFER MOUDRY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0011605) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000403) |
Enumeration Date | 2022-02-28 |
Last Update Date | 2022-05-26 |