| NPI | 1720446982 |
|---|---|
| Former Name | CARLY NICELEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-010616) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.010457) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2022-07-21 |