| NPI | 1619593639 |
|---|---|
| Former Name | MARY COLLETTE NICKLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC012855) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA BH002981) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2021-07-29 |