| NPI | 1750610200 |
|---|---|
| Former Name | PHYLLIS JO KANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC3941) |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2009-12-11 |