| 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 |