| NPI | 1750990453 |
|---|---|
| Former Name | CARLY RENEE DETTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926804) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO .0009922168) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2022-04-22 |