| NPI | 1750151502 |
|---|---|
| Former Name | NICOLE ANN GLENN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 8933) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-07-30 |