| NPI | 1619397528 |
|---|---|
| Former Name | AMANDA LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.01265) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178009928) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2019-05-02 |