NPI | 1902158918 |
---|---|
Former Name | LACY MICHELLE ALLEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11112) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5544) |
Enumeration Date | 2012-10-15 |
Last Update Date | 2012-10-15 |