NPI | 1720507692 |
---|---|
Former Name | KELSEY REDDEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC011637) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2017-09-12 |
Last Update Date | 2020-09-29 |