| NPI | 1649611351 |
|---|---|
| Former Name | BROOKE JADE SELLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1712) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2020-10-06 |