| NPI | 1669179313 |
|---|---|
| Former Name | BONNIE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-62856) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-ACLC-LIC-44180) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-05-02 |