| NPI | 1669751160 |
|---|---|
| Former Name | KELLY REBECCA WEISTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: GA LPC008109) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2020-01-27 |