| 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 |