| NPI | 1942551759 |
|---|---|
| Former Name | STEPHANIE DIANE ROBERTSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2012032155) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2012032155) |
| 101YP2500X Counselor, Professional (Licence: AZ lpc-18512) | |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2025-02-02 |