| NPI | 1720130297 |
|---|---|
| Former Name | SHANNON RENEE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC1245) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC1245) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2018-03-17 |