| NPI | 1700359411 |
|---|---|
| Former Name | TONJA EVONNE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60823298) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2019-01-04 |