| NPI | 1841675022 |
|---|---|
| Former Name | PAULETTE LAVINIA CANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE 1483) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2015-07-29 |