| NPI | 1902225501 |
|---|---|
| Former Name | KEISHA PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60721100) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2020-03-09 |