| NPI | 1831981141 |
|---|---|
| Former Name | KAITLYN MARIE VANDEWATER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 24031989) |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-05-21 |