| NPI | 1639842180 |
|---|---|
| Former Name | JESSICA MARIE TALBOT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CAC7669) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2021-07-30 |