| NPI | 1801243589 |
|---|---|
| Former Name | KELLY MARIE BURKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7089) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701015084) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2025-08-27 |