| NPI | 1922748532 |
|---|---|
| Former Name | SUSAN KAYE WQAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 01051150) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2022-03-31 |