| NPI | 1679936371 |
|---|---|
| Former Name | GRACE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 1388) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2024-03-03 |