| NPI | 1629330667 |
|---|---|
| Former Name | MITZI DANIELLE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 5771) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2015-01-21 |