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 |