NPI | 1821471129 |
---|---|
Former Name | MICAH SHIRES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0205691) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CO NLC.0104680) |
Enumeration Date | 2015-07-04 |
Last Update Date | 2023-09-12 |