| NPI | 1942500806 |
|---|---|
| Former Name | JESSICA DARLENE ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60145201) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2010-10-26 |