| NPI | 1770833055 |
|---|---|
| Former Name | MARISSA GAIL MUNDY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC008452) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC003577) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2016-06-28 |