| NPI | 1962189191 |
|---|---|
| Former Name | KARISSA ASHLEY FORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 15693) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2024-07-02 |