| NPI | 1780180828 |
|---|---|
| Former Name | THEODORA ANN STAVRAKAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122995) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 122995) |
| 1041C0700X Social Worker, Clinical (Licence: WA LW00004297) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2021-09-02 |