| NPI | 1730411638 |
|---|---|
| Former Name | GWENDOLYN PRENTINA PHILLIPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH 9889) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-012635-2016) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2017-02-22 |