| NPI | 1740745330 |
|---|---|
| Former Name | LISA BRODY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ 22608) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CO LPC.0013216) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2024-07-19 |