| 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 |