| NPI | 1649663485 |
|---|---|
| Former Name | CARRISSA LEE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801095484) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2019-03-20 |