| NPI | 1740300821 |
|---|---|
| Former Name | SANDRA J. AGOSTINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 11556-137) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15183-131) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2009-09-24 |