| NPI | 1902391154 |
|---|---|
| Former Name | ANDREA LYNN BURSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 161816) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2023-12-29 |