| NPI | 1952677783 |
|---|---|
| Former Name | ALLISSA DIANE PEDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 5695) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA PCCI 7) |
| 101YM0800X Counselor, Mental Health (Licence: CA PCCI 7) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2021-03-31 |