NPI | 1932666054 |
---|---|
Former Name | AMANDA LYNN BROWN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401016992) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.011694) |
Enumeration Date | 2019-02-25 |
Last Update Date | 2019-04-15 |