| NPI | 1669896304 |
|---|---|
| Former Name | HEATHER MARIE BRAGG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WV 2108) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WV 2108) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WV 2108) | |
| 101YM0800X Counselor Mental Health (Licence: WV 2108) | |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2014-02-18 |