| NPI | 1639415177 |
|---|---|
| Former Name | STEPHANIE BASHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 35454) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 12619) |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2017-03-07 |