| NPI | 1902528821 |
|---|---|
| Former Name | CASANDRA CHARLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 306434) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2022-09-16 |