| NPI | 1740973643 |
|---|---|
| Former Name | SUSAN LANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2023-06-21 |