| NPI | 1821681297 |
|---|---|
| Former Name | MARIAH DEE SHANNON GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2025-01-30 |