NPI | 1629614144 |
---|---|
Former Name | LARISA EVANS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY17813) |
Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA PSY17813) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY17813) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY17813) | |
Enumeration Date | 2019-11-19 |
Last Update Date | 2020-03-26 |