| NPI | 1831535236 |
|---|---|
| Former Name | MACEY LAUREN RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 102377) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: CA 102377) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2021-09-05 |