| NPI | 1669184966 |
|---|---|
| Former Name | LISA SIMONE BOURQUE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-22970) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW009286) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2026-04-21 |