NPI | 1700408325 |
---|---|
Former Name | JESSICA RUBLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW025204) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2020-05-18 |
Last Update Date | 2024-10-24 |