| NPI | 1649988841 |
|---|---|
| Former Name | CHARLENE M LOOSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-2106) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2022-11-07 |