| NPI | 1649454299 |
|---|---|
| Former Name | NATASHA WYNETTE BULLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 7609) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904007948) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN CSW0000006474) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2023-09-07 |