| NPI | 1861217044 |
|---|---|
| Former Name | CARRIE MAE JENNINGS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0704010332) |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2024-11-21 |