| NPI | 1639696610 |
|---|---|
| Former Name | DEIDRA KOSTELAC |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 119415) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 72411) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-03-25 |