NPI | 1720606387 |
---|---|
Former Name | AUTUMN MARIE WOODHOWARD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1885AD) |
Enumeration Date | 2020-07-10 |
Last Update Date | 2020-07-10 |