NPI | 1780332775 |
---|---|
Former Name | GEORGIA DEE CRAGGS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 1800002805) |
Additional Taxonomies | 101Y00000X Counselor (Licence: IL 1800002805) |
Enumeration Date | 2022-03-17 |
Last Update Date | 2022-03-17 |