NPI | 1669589859 |
---|---|
Former Name | DUSTIN CAMILLE ROLFSNESS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: MT 896 LAC) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MT 854 LCPC) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2007-07-08 |