| NPI | 1861718520 |
|---|---|
| Former Name | DE-ANDREA LESLIE BLAYLOCK-JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2010006307) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2023-05-09 |