| NPI | 1841362258 |
|---|---|
| Former Name | MARILYN SANFORD MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 1240) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 001914) |
| 163W00000X Registered Nurse (Licence: MO 096070) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |