| NPI | 1851795728 |
|---|---|
| Former Name | JACKIE S HENNING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 4727-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 16929-130) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16050-131) | |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2022-07-21 |