NPI | 1841653110 |
---|---|
Former Name | JOLENE DIZON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT107838) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF79716) |
Enumeration Date | 2016-04-03 |
Last Update Date | 2018-07-31 |