| NPI | 1639214323 |
|---|---|
| Former Name | MARILYN KAY SHANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 68000187) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 001548) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |