| NPI | 1811553902 |
|---|---|
| Former Name | CAITLIN MARIE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AK 4161) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2019-05-14 |