NPI | 1669112264 |
---|---|
Former Name | MEGAN LYDIC |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC015403) |
Additional Taxonomies | 101Y00000X Counselor (Licence: 1463088) |
Enumeration Date | 2022-03-31 |
Last Update Date | 2023-10-13 |