| NPI | 1760195176 |
|---|---|
| Former Name | CAROL ANN DERRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ 15277) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ 13113) |
| Enumeration Date | 2022-12-30 |
| Last Update Date | 2022-12-30 |