| NPI | 1891094371 |
|---|---|
| Former Name | JILL MARIE CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 075889) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4333) |
| 101YP2500X Counselor, Professional (Licence: NE 2108) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2014-12-12 |