| NPI | 1891018628 |
|---|---|
| Former Name | ANGELA M TATUM FAIRFAX |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DE PC0000438) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005056) |
| 225600000X Dance Therapist (Licence: MD BC-DMT 1008) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2024-06-28 |