NPI | 1780106500 |
---|---|
Former Name | CHARELL N MCKENZIE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122195) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 18545) |
Enumeration Date | 2017-07-13 |
Last Update Date | 2022-11-15 |