| NPI | 1861258386 |
|---|---|
| Former Name | SANDRA LYNN KNOWLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-R-52) |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2024-02-22 |