| NPI | 1649589771 |
|---|---|
| Former Name | BRENNA LAKAYE NICHOLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1292) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 01292) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2020-01-29 |