| NPI | 1770353872 |
|---|---|
| Former Name | JULIA RENEE SHACKELFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO61490408) |
| Enumeration Date | 2024-01-09 |
| Last Update Date | 2024-06-10 |