| NPI | 1912248394 |
|---|---|
| Former Name | JACQUELINE ROBERTS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: CO 13683) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CO 13683) |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2013-05-31 |