| NPI | 1629375134 | 
|---|---|
| Former Name | LIBBIE DAWNN IVERSON | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health | 
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW00018) | 
| Enumeration Date | 2011-02-17 | 
| Last Update Date | 2016-03-28 |