| NPI | 1679975635 |
|---|---|
| Former Name | SUSAN BLAKE PRENDERGRAST |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 1725) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY 235) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2018-07-31 |