| NPI | 1811762362 |
|---|---|
| Former Name | GLENNISHA MAXWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 74332) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 74332) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2025-08-11 |