| NPI | 1750592432 |
|---|---|
| Former Name | JESSIE LYNN CORDOVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 6354) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |