| NPI | 1639738768 |
|---|---|
| Former Name | NIKKI MOULTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 10571) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 6990) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-07-22 |