| NPI | 1629429790 |
|---|---|
| Former Name | PEARL LICANO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2024-08-28 |