| NPI | 1689320194 |
|---|---|
| Former Name | LAINA RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD 26012) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 26012) |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2023-07-25 |