| NPI | 1942636956 |
|---|---|
| Former Name | JACALYN GAYE WATSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 565) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2013-09-23 |