| NPI | 1922249648 |
|---|---|
| Former Name | MELISSA DIANNE VAN BLARICOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 1071) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 1071) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 1071) | |
| 101YM0800X Counselor, Mental Health (Licence: KY 1071) | |
| 102L00000X Psychoanalyst (Licence: KY 1071) | |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2022-11-09 |