| NPI | 1740678424 |
|---|---|
| Former Name | SHEA MARIE FITZGERALD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO 60270827) |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2022-06-01 |