NPI | 1952655383 |
---|---|
Former Name | STEPHANIE ANN UNDERWOOD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1200260-SUPV) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH c-1200260-trne) |
Enumeration Date | 2012-11-07 |
Last Update Date | 2021-10-14 |