| NPI | 1891349148 |
|---|---|
| Former Name | JAYDA KEYERRA BLOUNT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC12586) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD ADT1995) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2022-11-06 |