| NPI | 1902284458 |
|---|---|
| Former Name | MARYELLEN GARVEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 1196) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 611) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2015-05-19 |