| NPI | 1942679923 |
|---|---|
| Former Name | JENNA RAE WALKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: 6401014905) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401014905) |
| Enumeration Date | 2015-09-19 |
| Last Update Date | 2018-08-22 |