| NPI | 1861761082 |
|---|---|
| Former Name | MICHELLE MARIE THEISEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303224) |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2011-12-16 |