| NPI | 1841668761 |
|---|---|
| Former Name | JERILYN KEJICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 03 197) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-6094) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2019-04-08 |