NPI | 1942560032 |
---|---|
Former Name | EBONE LAVONE MITCHELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9494) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC4299) |
Enumeration Date | 2012-05-22 |
Last Update Date | 2013-08-21 |