NPI | 1780852160 |
---|---|
Former Name | CHARLEENE NICELY GALLENBERGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 0893) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC AD003667) |
103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NC LCAS 1142) | |
Enumeration Date | 2008-02-19 |
Last Update Date | 2018-04-17 |