| NPI | 1669691176 |
|---|---|
| Other Name | CORLISS WENTWORTH-THOMPSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00005457) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-03-25 |