NPI | 1689055949 |
---|---|
Former Name | KERRY CRAGIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401016553) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178011043) |
Enumeration Date | 2015-06-12 |
Last Update Date | 2018-04-24 |