| NPI | 1730902016 |
|---|---|
| Former Name | MADELINE PHELPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 151.0134198) |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-05 |