| NPI | 1699339978 |
|---|---|
| Former Name | AUTUMN ASHLEY DEKOSTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.013574) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 36433) | |
| 101YP2500X Counselor, Professional (Licence: IA 108785) | |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2024-06-27 |