NPI | 1639680689 |
---|---|
Former Name | JESSICA WALDEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 77988) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2017-10-17 |
Last Update Date | 2021-02-08 |