| NPI | 1821543000 |
|---|---|
| Former Name | JUSTINA KELSEY HAGEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 18186) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-18186) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2018-09-05 |