| NPI | 1649905852 |
|---|---|
| Former Name | JENNIFER STREETE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP1000607) |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2022-07-21 |