| NPI | 1902165343 |
|---|---|
| Former Name | SHANNON P FUKUSHIMA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2021-06-22 |