| NPI | 1679738736 |
|---|---|
| Former Name | MARY ANNE ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401010946) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401010946) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2008-07-28 |