NPI | 1942417696 |
---|---|
Former Name | MICHELLE DERESCHUK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3096) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT0324) |
Enumeration Date | 2007-05-16 |
Last Update Date | 2009-02-13 |