| NPI | 1780960575 |
|---|---|
| Former Name | TARA ELIZABETH PROFFITT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8160-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 23328) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149.012808) | |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2019-05-22 |