NPI | 1700228103 |
---|---|
Former Name | KELLY JO WILLIAMS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0012897) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000869) |
Enumeration Date | 2013-07-25 |
Last Update Date | 2022-02-03 |