| NPI | 1831604651 |
|---|---|
| Former Name | KIMBERLY RENEE RILEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 161155) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |