| NPI | 1700220399 |
|---|---|
| Former Name | KIMBERLY A TACKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC.954408-CS) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2013-04-25 |