NPI | 1801375431 |
---|---|
Former Name | TASHIA I NICHOLS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC10862) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP8898) |
Enumeration Date | 2018-08-14 |
Last Update Date | 2021-03-22 |