| NPI | 1962201087 |
|---|---|
| Former Name | MARY LAURA MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P017963) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-28193) |
| Enumeration Date | 2025-03-11 |
| Last Update Date | 2025-09-11 |