| NPI | 1649852666 |
|---|---|
| Former Name | VANESSA BROCKMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2023-04-07 |