| NPI | 1861885360 |
|---|---|
| Former Name | TABITHA MICHELLE BOONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 31762) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 11542) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2024-09-15 |