NPI | 1659629517 |
---|---|
Former Name | MEAGEN ELIZABETH DIANA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 002612) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1001) |
Enumeration Date | 2012-08-27 |
Last Update Date | 2023-11-09 |