| NPI | 1780170738 |
|---|---|
| Former Name | LAUREL ELIZABETH REVETTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013143) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P012609) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-24512) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2024-08-09 |