NPI | 1679172514 |
---|---|
Former Name | CONNIE TAYLOR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW20604) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL ISW15038) |
Enumeration Date | 2020-10-21 |
Last Update Date | 2022-12-13 |