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 |