| NPI | 1922682434 |
|---|---|
| Former Name | JODIE LYNN GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.176325) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-05-11 |