| NPI | 1801347620 |
|---|---|
| Former Name | TIFFANY BRYAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-19343) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2020-09-21 |