| NPI | 1700119609 |
|---|---|
| Former Name | TIFFANY KIRSTIN KERNUTT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 77298) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 03-088294) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2025-07-29 |