NPI | 1760996391 |
---|---|
Former Name | LISA MARIE CHRISTOFFER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 089395) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2017-11-17 |
Last Update Date | 2022-02-18 |