| 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 |