| NPI | 1770221939 |
|---|---|
| Former Name | ANGELA RANDOLPH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC CADC-2661) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC CADC-27410) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-05-26 |