| NPI | 1790200764 |
|---|---|
| Former Name | AMELIA LEIGH MITTAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 12640) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12640) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2020-04-14 |