NPI | 1720131782 |
---|---|
Former Name | SONJA ROCHELLE BUCKLES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC S9891) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 9891) |
101YP2500X Counselor, Professional (Licence: NC 9891) | |
Enumeration Date | 2007-01-20 |
Last Update Date | 2020-09-16 |