| NPI | 1790293959 |
|---|---|
| Former Name | JENNIFER ANN MCKINNEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60661346) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2020-06-23 |